Volume 155, Issue 5, Pages 1451-1462.e3 (November 2018) Effects of Allocating Livers for Transplantation Based on Model for End-Stage Liver Disease–Sodium Scores on Patient Outcomes  Shunji Nagai, Lucy C. Chau, Randolph E. Schilke, Mohamed Safwan, Michael Rizzari, Kelly Collins, Atsushi Yoshida, Marwan S. Abouljoud, Dilip Moonka  Gastroenterology  Volume 155, Issue 5, Pages 1451-1462.e3 (November 2018) DOI: 10.1053/j.gastro.2018.07.025 Copyright © 2018 AGA Institute Terms and Conditions

Gastroenterology 2018 155, 1451-1462. e3DOI: (10. 1053/j. gastro. 2018 Copyright © 2018 AGA Institute Terms and Conditions

Figure 1 (A) Score distribution at registration. (B) Score distribution at transplantation. (C) Comparisons of serum sodium concentration at transplantation according to score category. Gastroenterology 2018 155, 1451-1462.e3DOI: (10.1053/j.gastro.2018.07.025) Copyright © 2018 AGA Institute Terms and Conditions

Figure 2 Comparison of waitlist and post-transplantation outcomes between the MELD and MELD-Na periods (reference, MELD period; *P < .05). (A) HR for 90-day waitlist mortality in the MELD-Na period according to score categories. (B) HR for 90-day transplantation probability in the MELD-Na period according to score categories. (C) HR for 1-year liver graft loss in the MELD-Na period according to score range categories. Gastroenterology 2018 155, 1451-1462.e3DOI: (10.1053/j.gastro.2018.07.025) Copyright © 2018 AGA Institute Terms and Conditions

Figure 3 Comparison of cumulative incidence of waitlist mortality and transplantation between propensity score matched groups by period. (A) Cumulative incidence of waitlist mortality and transplantation. (B) Standardized difference before and after matching. The model achieved a standardized difference less than 0.10 (10%) after matching for all covariates. Gastroenterology 2018 155, 1451-1462.e3DOI: (10.1053/j.gastro.2018.07.025) Copyright © 2018 AGA Institute Terms and Conditions

Figure 4 Risk of hyponatremia for 90-day waitlist mortality in the MELD and MELD-Na periods (reference, normal sodium concentration [135–145 mmol/L]; *P < .05). (A) HR of mild hyponatremia (130–134 mmol/L) in MELD period. (B) HR of moderate hyponatremia (125–129 mmol/L) in MELD period. (C) HR of severe hyponatremia (<125 mmol/L) in MELD period. (D) HR of mild hyponatremia (130–134 mmol/L) in MELD-Na period. (E) HR of moderate hyponatremia (125–129 mmol/L) in MELD-Na period. (F) HR of severe hyponatremia (<125 mmol/L) in MELD-Na period. Gastroenterology 2018 155, 1451-1462.e3DOI: (10.1053/j.gastro.2018.07.025) Copyright © 2018 AGA Institute Terms and Conditions

Figure 5 Comparison of mortality risk in MELD-Na vs MELD period. Mortality risk by MELD and MELD-Na scores for liver transplant recipients was compared with that of patients on the LT waitlist. The columns showed HRs and P values by classifying the patients based on their final scores. Columns highlighted in light blue, gray, and orange represent “not favoring transplantation” (staying on the waitlist), “comparable,” and “favoring transplantation.” The transition point justifying survival benefit of LT shifted toward a higher score category. (A) Waitlist death includes “mortality” only. (B) Waitlist death includes “mortality” and “removal because too sick for transplantation.” Gastroenterology 2018 155, 1451-1462.e3DOI: (10.1053/j.gastro.2018.07.025) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 1 Comparison of waitlist and post-transplantation outcomes between MELD and MELD-Na periods (reference, MELD period; *P < .05). (a) HR for overall waitlist mortality in MELD-Na period according to score categories. (b) HR for overall transplantation probability in MELD-Na period according to score categories. Gastroenterology 2018 155, 1451-1462.e3DOI: (10.1053/j.gastro.2018.07.025) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 2 Comparison of cumulative incidence of transplantation and waitlist mortality. (a) Patients whose initial and final MELD score was lower than 15 but whose MELD-Na score was at least 15. (b) Patients whose initial MELD score was lower than 35 but whose MELD-Na score was at least 35. (c) Patients with initial MELD and MELD-Na scores of at least 35. Gastroenterology 2018 155, 1451-1462.e3DOI: (10.1053/j.gastro.2018.07.025) Copyright © 2018 AGA Institute Terms and Conditions